2015-08-02T20:37:19ZSocioeconomic position early in adolescence and mode of delivery later in life: findings from a portuguese birth cohorthttp://hdl.handle.net/10198/11747
Título: Socioeconomic position early in adolescence and mode of delivery later in life: findings from a portuguese birth cohort
Autor: Teixeira, Cristina; Silva, Susana; Severo, Milton; Barros, Henrique
Resumo: Objective: This study assessed the influence of socioeconomic position at 12 years of age (SEP-12) on the variability in cesarean rates later in life.
Methods: As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005–September/2006). Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women’s SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR) and respective 95% confidence interval (95% CI).
Results: The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p=0.100) among primiparous women; 14.2%, 11.6% and 15.5% (p=0.04) among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p=0.08) among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR=1.12;95%CI:1.01-1.24 comparing high with low SEP-12 and RR=1.03:95%CI:0.94-1.14 comparing intermediate with low SEP-12) not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean.
Conclusions: The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth.2015-01-01T00:00:00ZBilirubin levels and redox status in a young healthy populationhttp://hdl.handle.net/10198/10912
Título: Bilirubin levels and redox status in a young healthy population
Autor: Rodrigues, Carina; Rocha, Susana; Nascimento, Henrique; Vieira, Emília; Santos, Rosário; Santos-Silva, Alice; Costa, Elísio; Bronze-da-Rocha, Elsa
Resumo: The additional TA repeat (c.-41_
-40dupTA) in the promoter of the uridine
diphosphate glucuronosyltransferase
(UGT1A1) gene is associated with a decrease
in gene transcription, a decline in
bilirubin conjugation and, therefore, with
an increase in circulating unconjugated bilirubin
(UCB) [1] . The TA repeat polymorphism
is remarkably prevalent in the Caucasian
white population and is the main
cause of Gilbert’s syndrome [1] .
Bilirubin, the key metabolic product of
hemoglobin (Hb) catabolism, has antioxidant
properties that seem to have a protective
effect in oxidative stress conditions,
such as in atherosclerosis, coronary heart
disease, inflammation, and cancer [2] .
Some studies showed that high levels of bilirubin
can be toxic to neurons in newborn
infants.2013-01-01T00:00:00ZRisk of caesarean section after induced labour: do hospitals make a difference?http://hdl.handle.net/10198/8886
Título: Risk of caesarean section after induced labour: do hospitals make a difference?
Autor: Teixeira, Cristina; Correia, Sofia; Barros, Henrique
Resumo: Background: There is a well-known relationship between induced labour and caesarean rates. However, it remains
unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in
obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the
occurrence of caesarean section after induced labour.
As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who
underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August
2006). The indications for induction were classified according to the guidelines of the American and the Royal
Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association
between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95%
confidence interval (95% CI) were computed.
The proportion of women who were induced without formal clinical indications varied among hospitals
from 20.3% to 45.5% (p < 0.001). After adjusting for confounders, the risk of undergoing a caesarean section after
induced labour remained significantly different between the hospitals, for the cases in which there was no evident
indication for induction [the highest PR reaching 1.86 (95% CI, 1.23–2.82)] and also when at least one such
indication was present [1.53 (95% CI, 1.12–2.10)]. This pattern was also observed among the primiparous cephalic
term induced women [the highest PR reaching 2.06 (95% CI, 1.23–2.82) when there was no evident indication for
induction and 1.61 (95% CI, 1.11–2.34) when at least one such indication was present].
Caesarean section after induced labour varied significantly across hospitals where similar outcomes
were expected. The effect was more evident when the induction was not based on the unequivocal presence of
commonly accepted indications.2013-01-01T00:00:00ZThe Bishop score as a determinant of labour induction success: a systematic review and meta-analysishttp://hdl.handle.net/10198/8378
Título: The Bishop score as a determinant of labour induction success: a systematic review and meta-analysis
Autor: Teixeira, Cristina; Lunet, Nuno; Rodrigues, Teresa; Barros, Henrique
Resumo: PURPOSE: To evaluate the association between the Bishop Score and successful induction. STUDY STRATEGY AND SELECTION CRITERIA: We searched the PubMed and the lists of references of relevant studies to identify reports on the association between Bishop Score and achieving active phase of labour or vaginal delivery. DATA COLLECTION AND ANALYSIS: We abstracted crude or adjusted measures of association from studies. Summary odds ratio (OR) and summary hazard ratio (HR), and 95 % confidence interval (95 % CI) were obtained by random effects meta-analysis. Study heterogeneity was assessed using the I (2) test. RESULTS: Fifty-nine studies met the inclusion criteria. Analyses with crude ORs showed that women with higher versus lower Bishop Score were more likely to achieve vaginal delivery either with no time limit for this to occur, or within a certain time interval; the summary ORs according to the Bishop Score cutoff ranged from 1.98 (95 % CI: 1.58-2.48; I (2) = 36.6 %) to 5.48 (95 % CI: 1.67-17.96; I (2) = 0.0 %) and from 2.15 (95 % CI: 1.36-3.40; I (2) = 0.0 %) to 4.22 (95 % CI: 2.48-7.17; I (2) = 11.0 %), respectively. Summary estimates per unit increase in the Bishop Score, based on adjusted ORs, showed a positive association with achieving vaginal delivery, either with no time limit (OR(summary) = 1.33; 95 % CI: 1.13-1.56; I (2) = 66.1 %) or within a certain time interval (OR(summary) = 1.52; 95 % CI: 1.37-1.70; I (2) = 42.4 %). Summary HRs per unit increase in Bishop Score showed an association with induction to vaginal delivery (HR(summary) = 1.28; 95 % CI: 1.21-1.36; I (2) = 0.0 %), but not with induction to active phase (HR(summary) = 1.21; 95 % CI: 0.88-1.68; I (2) = 70.7 %) time interval. CONCLUSIONS: Bishop Score seems be a determinant of achieving vaginal delivery and is associated with induction-to-vaginal delivery time interval.2012-01-01T00:00:00Z